Kurt Fearnley Scholarship 2020

Kurt Fearnley Scholarship 2020

Application Form
APPLICATIONS TO BE RECEIVED BY 5pm on Friday 29 November 2019

Applicants should read the Kurt Fearnley Guidelines (below) prior to completing this Application Form. Eligibility does not guarantee a scholarship.

If you would prefer to complete a HARD COPY of this form, please email cga@commonwealthgames.com.au

Event(s)

QUESTION 5: Do you have a training and competition plan or Individual Athlete Performance Plan in place? If so, please attach.

Yes No
If YES, please upload Training Plan

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If YES, please upload Competition Plan

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Representative & Ranking Details
QUESTION 1: Have you represented Australia at your sport’s nominated benchmark event (e.g. Commonwealth Games / World Championships) in the past 2 years? (Please tick)

Yes No

QUESTION 2: At the end of the most recent competition season, did you have an International ranking?

Yes No

QUESTION 3: At the end of the most recent competition season, did you have an Australian ranking?

Yes No

If YES, please advise of your ranking in each category into the relevant box(es) below:

National Sporting Organisation details

Details of representative that can verify your results
National Sporting Organisation
NSO Contact Name
NSO Contact Telephone

2019 Performance Details

Please list your performances in all major competitive events attended during the period of 1 November 2018 to 31 October 2019. In particular your performances at Benchmark International, Other International and National events.

Declaration
I wish to be considered for a Kurt Fearnley Scholarship. All information submitted on this form is correct and complete.

I understand that the CGA reserves the right to vary or reverse the decision regarding my scholarship on the basis of incorrect or incomplete information. I am also aware that CGA will be seeking verification and endorsement through the State Sporting Organisation / National Sporting Organisation prior to awarding scholarships.

In addition, I understand that Kurt Fearnley Scholarships are limited, and these will be awarded on merits of applications and priorities of CGA. Application and eligibility for a scholarship does not guarantee selection.
Applicant Signature *

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Date

Month Day Year
Date Date Picker Icon
Applicants Under 18 Years of Age

For applicants under 18 years of age, the parent, guardian or custodian who is the first legal point of contact must sign below.
Parent/Guardian Name
Parent/Guardian Street No & Name
Parent/Guardian Suburb
Parent/Guardian State
Parent/Guardian Postcode
Parent/Guardian relationship to applicant
Parent/Guardian Signature

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Date

Month Day Year
Date Date Picker Icon
Should be Empty:

	2018	2019
Australian Junior
Australian Senior

Sport & Event